Mr. Denham: I did not intent to give the impression that clause 60 provides that this group must have the same power under all circumstances. For example, it is necessary for prescribing nurses to be specifically trained in prescription before they can prescribe. Clearly, location and function is important, not just the membership of a profession or a wider policy. The hon. Gentleman is right about that.
Amendment agreed to.
Mr. Swayne: I beg to move amendment No. 278, in page 54, line 12, at end insert
`(1C) An order under subsection (1A) may specify requirement as to indemnity insurance which must be maintained by a person exercising any rights conferred upon him by such order.'.
The amendment would provide a useful power for the Secretary of State when making orders under subsection (1A). It would enable him, but it does not require him, to specify that indemnity insurance should be maintained by those exercising rights conferred on them by such orders. In other words, those who have acquired the new prescribing rights may, at the discretion of the Secretary of State, have to take out indemnity insurance.
It is a probing amendment, to try to put pressure on the Minister to explore what should happen when something goes wrong and where liability should lie. It would also have the useful function of providing a means of redress through indemnity insurance. However, I caution the Minister, because indemnity insurance is not a cheap optionI am sure that he already knows that. Such insurance is, by custom, relatively expensive, and Ministers may wish to protect professionals from that requirement and allow the NHS to continue to pay out rather than have the professionals paying out through insurance. That is an entirely proper consideration.
Dr. Brand: It is a useful amendment. Indeed, I hope that the Government will consider tabling a similar amendment on Report. Some members of the national health service family are already covered through national health service indemnity arrangements, but it is vital that those who are not otherwise coveredespecially those working independentlyshould carry indemnity insurance or be a member of an association that covers them, otherwise patients will be left without effective redress should things go wrong.
Mr. Denham: The amendment raises a series of interesting issues. As the hon. Member for New Forest, West said, it would give Ministers the power by order to require new prescribers to carry indemnity insurance. It is possible to see both sides of the argument. In some cases, legislative powers already existfor instance, the Health Act 1999 provides the power to regulate new professions. On the other hand, the vast majority of registered health professionals already carry indemnity cover through their membership of professional organisations or trade unions. For example, physiotherapists and chiropodists carry indemnity insurance through their membership of their professional bodies, the Chartered Society of Physiotherapists and the Society of Chiropodists and Podiatrists. The UKCC, which is the statutory regulatory body for nurses, midwives and health visitors, strongly advises all nurses in practice to have indemnity insurance through one of the professional organisations or trade unions. Of course, where new prescribers are employed by an NHS trust or primary care trust, NHS employers' liability will apply.
As Committee members will know, the Health Act 1999 gave us the ability to require indemnity insurance for general medical and dental practitioners and the facility to extend that requirement to optometrists or pharmacists, the need for which we are keeping under review. For other professions, it is currently a matter for guidance and strong recommendation by the existing regulatory bodies.
I have thought carefully, and I think the issue is whether clause 60 is the right place for the provision and whether it should be specifically in relation to prescribing, or whether at some point it should be addressed more generally under the law relating to professions. My feeling is that this is not the appropriate place to take this measure although I recognise the argumentsand the reasons for them. The hon. Gentleman expressed some awareness of the dilemmas that are involved. If we were to be persuaded, however, that there was a need to enforce professions to have liability insurance, we should apply such a measure to the professions and not necessarily just in relation to clause 60 of this Bill.
Mr. Swayne: I thank the Minister for his comments and I concur largely with the analysis he has give, although I think that this is an that is worth considering further and we may do so. Meanwhile, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 60, as amended, ordered to stand part of the Bill.
Dispensing of NHS prescriptions and provision of pharmaceutical services
Amendment made: No. 213, in page 35, line 29, at end insert `;
(i) any other description of persons which appears to the Secretary of State to be a description of persons whose profession is regulated by or under a provision of, or made under, an Act of the Scottish Parliament or Northern Ireland legislation and which the Secretary of State considers it appropriate to specify.'.[Mr. Denham.]
Remote provision of pharmaceutical, etc. services
Amendment proposed: No. 214, in page 37, line 6, at end insert
`(whether by the Secretary of State or by another person so specified)'.[Mr. Denham.]
Mr. Swayne: I do not wish to be a Luddite, but I do have reservations about remote prescribing. I would like the Minister to say a few words about what safeguards there will be because it strikes me that the advantage of the local pharmaceutical services is that they provide a higher-quality service. Many people may have become accustomed to that level of service and have enjoyed it, and the LPS scheme allows greater scope to develop that high quality of service to provide the added value that those pharmacy services can make available to the public.
I wonder whether that added value is available by electronic mail. It is only by consulting the pharmacist that the medicine management that we have discussed today would allow the exploration of the interaction between a medicine that has been prescribed against medicines that were bought over the counter for other conditions. If pharmacy services are provided via electronic mail, is that added value to be had? The danger is that the provisions for remote prescribing have every possibility of denying patients the advantages of local pharmaceutical services. I am looking for reassurance from the Minister on that scorethat the problems have been thought about and that safeguards will be in place.
Mr. Denham: We are discussing an appropriate and sensible development. Clauses 42 and 43 remove legal obstacles to patients having their NHS prescriptions dispensed by mail order or by internet-based e-pharmacies. A small number of pharmacies in the United Kingdom sell medicines and, to a limited extent, dispense prescriptions. I said earlier that we do not intent to tell patients how they should have their prescriptions dispensed. Freedom of choice has always been at the heart of NHS dispensing. I do not see why NHS patients should be denied choices that are open to people with private prescriptions.
The key factor is that mail order and on-line pharmacies must meet the same legal and professional standards as any other pharmacy. That means that all pharmacy and prescription-only medicines must be supplied only from registered pharmacy premises, and such premises are regularly inspected by the Royal Pharmaceutical Society of Great Britain. In addition, pharmacy and prescription-only medicines may be supplied only by, or under the supervision of, a registered pharmacist. For prescription-only medicines there must also be a prescription. Breach of any of those rules is a criminal offence.
As well as legal controls, there are professional controls. Pharmacists and e-pharmacists must have the same professionalism and ethical conduct as other pharmacists. They must also acknowledge the special issues that may arise when dealing with patients at a distance.
The Royal Pharmaceutical Society of Great Britain's code of ethics includes a standard for the provision of on-line pharmacy services. That standard requires on-line pharmacies to observe British Standards Institution standard BS7799 to ensure the confidentiality and integrity of patient information. It requires on-line pharmacies to ensure that people requesting a pharmacy-only medicine complete a questionnaire appropriate to the product concerned before a decision is made to supply it. If the request or the patient's answer suggests that he would better served by a face-to-face consultation, the pharmacist is required to refer the patient to a convenient pharmacy.
The standard also requires on-line pharmacies to keep records that identify the pharmacist who authorises every supply of a pharmacy or prescription-only medicine. For sales of pharmacy medicines, the records, which must be kept for two years, must give details of the transaction and the information upon which the decision to supply was based. Failure to comply would form the basis of a complaint of misconduct the statutory committee of the Royal Pharmaceutical Society of Great Britain, which has the power ultimately to strike off pharmacists found guilty of misconduct. In the case of a pharmacy company, the company's pharmaceutical superintendent be liable, as he would have personal responsibility for the management of the whole company's pharmacy business as well as for the pharmacy in question. Our view is that if those legal and ethical safeguards are met there is no reason why e-pharmacy should not safely provide patients with new choices in obtaining their medicines.
Clause 43 makes further amendments in consequence of the provisions in clause 41 that allow for the provision of pharmaceutical services by remote means. For consistency, it makes explicit that additional pharmaceutical services may include activities carried out away from the contractor's premises and across health authority boundaries. Additional pharmaceutical services are certain extra services that help authorities arrange with pharmacies under directions given by the Secretary of State rather than regulations. The clause makes a number of other essentially technical changes.
Amendment agreed to.
Clause 43, as amended, ordered to stand part of the Bill.
Dispensing of NHS prescriptions